MEDICARE: DR. LUCINDA CASSADY PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY8504	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144359837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCINDA CASSADY PH.D

Provider Business Mailing Address
First Line	:	471 CAROLINA RD
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-2526
Country	:	US
Telephone Number	:	858-755-7027
Fax Number	:

Provider Business Practice Location Address
First Line	:	2148 BROADWAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-1829
Country	:	US
Telephone Number	:	619-269-6290
Fax Number	:	619-269-7063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/09/2007

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